Individual
ALEXY SHALE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
1840 LANTAFF BLVD STE 100, MADISONVILLE, KY 42431-9403
(270) 601-4235
(270) 350-4673
Mailing address
PO BOX 250, KUTTAWA, KY 42055-0250
(270) 601-4235
(270) 350-4673
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
252824
KY
Other
Enumeration date
12/11/2017
Last updated
06/16/2018
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